Off-face resurfacing: Researchers continue to seek quick and effective solutions

October 1, 2008

Options for off-face resurfacing include ablative treatments, nonablative treatments, photo- dynamic therapy and fractional ablative treatments, an expert says.

Key Points

"There's very little hard data in the literature. We need more data," says Kimberly Butterwick, M.D., a board-certified dermatologist who practices at La Jolla Spa MD, La Jolla, Calif.

However, there's no shortage of demand for these treatments.

However, she says that compared to facial skin, non-facial areas have thinner skin with fewer adnexal structures, which means nonfacial skin will heal more slowly, with higher chances of scarring.

"It's almost too difficult to get good results," particularly on the legs, she says.

Accordingly, physicians must approach these areas with much caution, especially when treating them for the first time.

Dr. Butterwick says when she began off-face resurfacing, "I always wanted the Cook body peel to work, but results were very splotchy and impossible to reproduce," although further research with this peel might produce more uniform results.

On the whole, for off-face resurfacing, topicals work very slowly and provide very mild results, Dr. Butterwick says. "The peels are somewhat unpredictable," she says.

However, intense pulsed light (IPL) devices and lasers work very well off the face.

Ablative options

Ablative options for nonfacial areas include the carbon dioxide and the erbium (2,940 nm) lasers, the Pearl (2,790 nm, Cutera) and plasma resurfacing (Portrait PSR3, Rhytec). Dr. Butterwick and her colleagues began performing neck resurfacing with CO2 and erbium lasers more than a decade ago, she says.

In one series of 10 patients given low-density treatments with the CO2 laser, four experienced patchy hypopigmentation and three experienced scarring, particularly on the lower neck (Fitzpatrick RE, Goldman MP, Sriprachya-Anunt S. Lasers Surg Med. 2001;28(2):145-149).

Therefore, she says, physicians should be very careful when performing CO2 ablative resurfacing in this area.

Patient study

A 200-patient study of CO2 laser treatments for the neck found that one could avoid scarring by super-hydrating the neck area with EMLA (lidocaine/prilocaine, APP) for two to three hours pretreatment and lowering fluences (Kilmer SL et al. Lasers Surg Med. 2006 Aug;38(7):653-657).

Physicians also attempted single-pass CO2 treatments here, she says, "But this method gave only mild benefits and took two weeks to heal."

Dr. Butterwick says she still uses erbium lasers often, but not for the hands, because skin here takes two to three weeks to heal after ablative treatments.

For patients with a substantial number of lentigines who want ablative resurfacing, she says, "I take an alexandrite or ruby laser and treat the darker lentigines first, then follow right up with an ablative or fractionated laser."

Complications associated with ablative laser resurfacing of nonfacial sites include infection, persistent erythema and hypo- or hyperpigmentation.

"When you're working off the face," Dr. Butterwick says, "always consider that things go wrong more easily."